Warning:
Pharmacological treatment is always recommended under doctor's supervision. Consult your doctor before taking any of the medications mentioned below.

What Medications Can Ease PMS?

In PMS, there are treatment options suitable for etiological theories. The first option is non-hormonal therapy to increase the central seratogenic transmission, and the second option is hormonal therapy to increase the ovarian hormone level. At the same time, symptomatic treatment may be applied to improve some premenstrual symptoms.

For many women, lifestyle changes can help relieve PMS symptoms. But depending on the severity of your symptoms, your doctor may prescribe one or more medications for premenstrual syndrome.

1. Selective serotonin reuptake inhibitors (SSRIs)

Warning:
Seek medical advice before using Selective Serotonin Reuptake Inhibitors (SSRIs), as they cannot be purchased over the counter.

What Are Selective Serotonin Reuptake Inhibitors (SSRIs)?

Selective serotonin reuptake inhibitors (SSRIs) are anti-depressants that have been successful in reducing mood symptoms. This includes:

• Fluoxetine (Prozac)
• Paroxetine (Paxil, Pexeva)
• Sertraline (Zoloft) [1]

How Do SSRIs Work?

These medications increase the concentration of a neurotransmitter (chemical messenger) in the brain called serotonin, which is thought to have a good influence on mood, emotion and sleep. After carrying a message, serotonin is usually reabsorbed by the nerve cells (known as "reuptake"). SSRIs work by blocking ("inhibiting") reuptake, meaning more serotonin is available to pass further messages between nearby nerve cells.

But you have to take SSRIs for at least three months before they start working. They weren't found to be more effective when taken continuously rather than only during the second half of the cycle.

It's important for women who are considering taking antidepressants to know what side effects they could have. SSRIs can cause things like nausea, sleep problems, and decreased libido. [2]

What Is the Efficacy of SSRIs for PMS?

Methods: Studies were done which included large-scale systematic reviews and meta-analyses of 29–34 randomized controlled trials, assessing the efficacy of SSRIs in treating PMS/PMDD. They compared continuous vs luteal-phase dosing and measured symptom reduction, response rates, and side effects. Participant data ranged from hundreds to over 4,000 women across varied age groups and symptom severity.

Results: SSRIs significantly reduced PMS/PMDD symptoms compared to placebo, with moderate-to-large effect sizes. Continuous dosing was slightly more effective than luteal-phase dosing, though both were beneficial. Side effects like nausea and fatigue were more common with SSRIs, leading to higher dropout rates than placebo. No single SSRI proved superior across studies.

Conclusion: SSRIs are effective and recommended as a first-line treatment for moderate-to-severe PMS and PMDD. Side effects are common but generally manageable. Treatment choice should be individualized based on symptom severity, tolerance, and patient preference.[3][4][5][6]

What Are the Side Effects of SSRIs?

Short-term effects: Nausea, decreased energy, drowsiness, fatigue, and sweating.

Long-term effects: Sexual disturbances, sleep disturbance, and weight gain.[7]

2. Combined oral contraceptives

Warning:
Talk to a medical professional before starting combined oral contraceptives, as they require a prescription and are not available over the counter.

What Are Combined Oral Contraceptives?

Combination birth control pills, also known as the pill, are oral contraceptives that contain estrogen and a progestin.

Combination birth control pills come in different mixtures of active and inactive pills, including:

Conventional pack: One common type contains 21 active pills and seven inactive pills. Inactive pills do not contain hormones. Formulations containing 24 active pills and four inactive pills, known as a shortened pill-free interval, also are available. Some newer pills may contain only two inactive pills. You take a pill every day and start a new pack when you finish the old one. Packs usually contain 28 days of pills. Bleeding may occur every month during the time when you take the inactive pills that are at the end of each pack.

Extended-cycle pack: These packs typically contain 84 active pills and seven inactive pills. Bleeding generally occurs only four times a year during the seven days you take the inactive pills.

Continuous-dosing pack: A 365-day pill also is available. You take this pill every day at the same time. For some people, periods stop altogether. For others, periods become significantly lighter. You do not take any inactive pills.[8]

How Do Combined Oral Contraceptives Work?

Combination pills contain synthetic versions of estrogen and progesterone, and they work by stopping ovulation.

At first, it gives a steady dose of estrogen with no peak so there is no signal to ovaries to release an egg. Then the pill starts delivering a fixed level of progesterone throughout its use to stop the uterine lining from growing.

Finally, most pills have a week of placebos, which make hormone levels fall and your period starts. It’s actually called withdrawal bleeding when you’re on the pill because it’s a reaction to the loss of hormones.

Because the pill delivers everything in steady doses, it can make your hormone levels more predictable and your period symptoms less unpleasant.[8]

What Is the Efficacy of Combined Oral Contraceptives for PMS?

Methods: Studies were conducted to evaluate the efficacy of COCs in treating PMS. Wichianpitaya et al. (2013) conducted an open-label randomized controlled trial comparing drospirenone- and desogestrel-based COCs over 6 cycles in 90 women with PMS. De Wit et al. (2021) performed a systematic review and Bayesian meta-analysis of 9 RCTs (n ≈ 1205), assessing various COC formulations versus placebo over at least 3 cycles, focusing on overall and depressive premenstrual symptoms.[9][10]

Results: Both studies found that COCs significantly reduced overall premenstrual symptoms. Wichianpitaya et al. reported greater and earlier symptom relief with drospirenone-based COCs compared to desogestrel. De Wit et al.’s meta-analysis confirmed COCs were more effective than placebo for overall symptoms, but not significantly so for depressive symptoms.

Conclusion: COCs are effective in reducing overall premenstrual symptoms in women with PMS. While drospirenone-based COCs may offer faster relief, no single formulation shows clear superiority across studies, especially for depressive symptoms.

What Are the Side Effects of Combined Oral Contraceptives?

Short-term effects: Nausea, headache, irritability and moodiness, breast tenderness.[8]

Long-term effects: Long-term side effects of birth control pills may include a higher risk of blood clots and some cancers. However, hormonal methods of birth control are safe for most people, as long as they have a doctor’s approval.[11]

Medically reviewed by: Dr Yash Bahuguna.

Researched by: Dr Inara Isani.

Written by: Avantika Sukhia.

References

1. Chu A, Wadhwa R. Selective serotonin reuptake inhibitors. In StatPearls [Internet]. StatPearls Publishing; 2023 May 1.
2. Institute for Quality and Efficiency in Health Care (IQWiG). Premenstrual syndrome: Learn more – Treatment for PMS. Cologne (DE): IQWiG; 2022 May 18 [cited 2025 Apr 23].
3. Jespersen C, Lauritsen MP, Frokjaer VG, Schroll JB. Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder. Cochrane Database of Systematic Reviews. 2024;(8).
4. Reilly TJ, Wallman P, Clark I, Knox CL, Craig MC, Taylor D. Intermittent selective serotonin reuptake inhibitors for premenstrual syndromes: A systematic review and meta-analysis of randomised trials. Journal of Psychopharmacology. 2023 Mar;37(3):261–7.
5. Shah NR, Jones JB, Aperi J, Shemtov R, Karne A, Borenstein J. Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder: a meta-analysis. Obstetrics & Gynecology. 2008 May 1;111(5):1175–82.
6. Dimmock PW, Wyatt KM, Jones PW, O'Brien PS. Efficacy of selective serotonin-reuptake inhibitors in premenstrual syndrome: a systematic review. The Lancet. 2000 Sep 30;356(9236):1131–6.
7. Ferguson JM. SSRI antidepressant medications: adverse effects and tolerability. Primary Care Companion to the Journal of Clinical Psychiatry. 2001 Feb;3(1):22.
8. Cooper DB, Patel P, Mahdy H. Oral contraceptive pills.
9. de Wit AE, de Vries YA, de Boer MK, Scheper C, Fokkema A, Janssen CA, Giltay EJ, Schoevers RA. Efficacy of combined oral contraceptives for depressive symptoms and overall symptomatology in premenstrual syndrome: pairwise and network meta-analysis of randomized trials. American Journal of Obstetrics and Gynecology. 2021 Dec 1;225(6):624–33.
10. Wichianpitaya J, Taneepanichskul S. A Comparative Efficacy of Low-Dose Combined Oral Contraceptives Containing Desogestrel and Drospirenone in Premenstrual Symptoms. Obstetrics and Gynecology International. 2013;2013(1):487143.
11. Smith JS, Green J, de Gonzalez AB, Appleby P, Peto J, Plummer M, Franceschi S, Beral V. Cervical cancer and use of hormonal contraceptives: a systematic review. The Lancet. 2003 Apr 5;361(9364):1159–67.